Atypical Lupus Erythematosus Panniculitis Progressing to Antinuclear Antibody–Negative Systemic Lupus Erythematosus

Abstract

We describe a case of LEp affecting unusual sites: the parotid gland, eyelid, and scalp. Subsequently, the patient progressed to antinuclear antibody-negative systemic LE.

Distinctive lupus panniculitis of scalp with linear alopecia along Blaschko's lines: a review of the literature

“…Despite the appearance of LEP surface with DLE features, other scalp abnormalities could possibly be presented, including scarring alopecia (five cases, 25%), erythema (14 cases, 70%), induration (five cases, 25%), tenderness (six cases, 30%), mass (two cases, 10%), skin atrophy (two cases, 10%), and follicular papule (5%) . Although, there were 20% of the alopecia cases without other abnormal physical findings on the scalp.…”

“…The histopathologic examination revealed a lobular lymphocytic panniculitis (100%) with mucin deposition (65%), hyaline fat degeneration (60%), basal vacuolization or thickening of basement membrane (20%), and epidermal changes of DLE (30%) . The infiltration by plasma cell (15%) and nodular lymphoid aggregation (15%) was also illustrated in Figure , while direct immunofluorescences (DIF) was positive in 20%, comprising of IgM, IgG, and C3 at basement membrane, and follicular epithelium as typical LEP . Besides, the immunohistochemical studies of LPS revealed the presence of CD3 + , CD4 + , CD8 + , CD56‐T cell with normal CD4: CD8 ratio and no abnormal polyclonality on T‐cell receptor gene rearrangement similar to the typical LEP …”

“…Once the dermis is also involved, the follicles are often consequently destroyed with a scarring alopecia. 8,11,14,15 erythema (14 cases, 70%), 3,7-10,14-20 induration (five cases, 25%), 8,14,16,17,18 tenderness (six cases, 30%), [7][8][9]16,18,19 mass (two cases, 10%), 19,21 skin atrophy (two cases, 10%), 7,20 and follicular papule (5%). 15 Although, there were 20% of the alopecia cases without other abnormal physical findings on the scalp.…”

“…15 Although, there were 20% of the alopecia cases without other abnormal physical findings on the scalp. 4,20,22,23 Consequently, the extent of inflammation in LPS could be involved from the subcutaneous that caused lipoatrophy and to the dermis that resulted in skin atrophy and scar.…”

“…8,14 In addition, Anti-Ro/SSA antibody was positive in 10% 16,18 and compatible with the detection rate in chronic cutaneous LE (22%). 30 The histopathologic examination revealed a lobular lymphocytic panniculitis (100%) with mucin deposition (65%), 3,4,9,10,[15][16][17][20][21][22][23] hyaline fat degeneration (60%), 3,4,7,[9][10][11]15,16,18,20,22 basal vacuolization or thickening of basement membrane (20%), 7,11,15,18 and epidermal changes of DLE (30%). 3,7,11,15,19,20 The infiltration by plasma cell (15%) 4,18,22 and nodular lymphoid aggregation (15%) 9,15,18 was also illustrated in Figure 4, while direct immunofluorescences (DIF) was positive in 20%, comprising of IgM, IgG, and C3 at basement membrane, 16,18,19 and follicular ep...…”